Exam 3 Practice Test Flashcards
Parkinson’s
A young patient has just been diagnosed with mild Parkinson’s. What drug should the nurse expect as first line treatment?
A dopamine agonist like pramipexole (mirapex). Levodopa wears off in time, and younger patients can handle the SE.
The nurse is preparing to give a drug to reduce the wearing-off effect of levodopa. What is the drug, and when is the nurse preparing it?
Selegiline (Eldepryl) in the morning because of insomnia
A patient is on amantadine to reduce dyskinesias caused by levodopa. Which side effects should the nurse EXPECT?
- urinary retention
- orthostatic hypotension
- livedo reticularis
- CNS effects
- gambling
- urinary retention (anticholinergic)
- livedo reticularis (mottled discoloration)
- CNS effects
- -
- orthostatic hypotension is selegiline
- gambling is pramipexole
A patient with Parkinson’s is complaining of dry mouth. Which two drugs might the nurse expect to see in their chart?
- benztropine (Cogentin) is an anticholinergic
- amantadine is an antiviral
A patient with Parkinson’s was advised to avoid high-protein meals. What drug combination are they on?
Levodopa/Carbidopa – n/v is a huge side effect.
A patient with Parkinson’s is extremely agitated and is showing signs that they might become psychotic. Is the nurse surprised, and what do they avoid?
No – psychosis, anxiety, and agitation are known AE.
Avoid 1st gen antipsychotics like Haldol.
A nurse is preparing a patient’s first dose of donepezil for Alzheimer’s disease. They note that the patient is also on prozac. How does the nurse proceed?
Gives as planned; anticholinergics are the drug-drug for donepezil.
Which Alzheimer’s drug needs to be given late in the day?
donepezil (Aricept) due to bradycardia, fainting, falls
A caregiver for an Alzheimer’s patient asks for some Miralax to help their loved one poop. Which drug does the nurse expect to see in the patient’s chart?
memantine
donepezil is a cholinesterase inhibitor so has opposite of anticholinergic SE –> diarrhea
After starting a patient on memantine, they seem much more disoriented and complain of a headache. Is that expected or unexpected?
Expected – too much calcium has entered the neurons
A patient’s caregiver says they haven’t seen any improvement over the three days the patient has been on donepezil. Is that expected or unexpected?
Expected: low and slow, and a looooong (70 hour) half life
A patient reports sleep driving on zolpidem (Ambien). Which benzodiazepine would also be a sleep aid?
triazolam (Halcion)
A patient has a substance use history and insomnia. Which drug might be a good choice for a sleep aid?
zolpidem or hydroxyzine
A patient states that they skip their buspirone when they’re having a few glasses of wine since they only need it when they’re anxious. Does the nurse intervene?
Yes. It’s not for PRN use, and it doesn’t have an ETOH interaction.
A patient who has been given IV midazolam has a BP of 80/40. What does the nurse expect?
flumazenil admin over 15 seconds, repeat every minute
A patient with suicidal ideation states that their anxiety has gotten really bad. Can they have a benzo?
Nope, try buspirone for daily or hydroxyzine for PRN
A patient’s EKG shows a prolonged QT interval. Which anxiolytic does the nurse expect in the patient’s medication list?
long-term hydroxyzine
A patient with PTSD wants an anxiolytic. What does the nurse expect?
An SSRI – it’s the only thing proven to help.
A patient reports dry mouth with hydroxyzine and sips on grapefruit juice throughout the day. Is that okay?
Yep – dry mouth is expected, and it’s Buspar that has the grapefruit interaction.
A patient on phenytoin reports a rash. Okay?
NOPE – SJS/toxic epidermal necrolysis
Which AED should a patient tell their dentist about?
phenytoin
A patient receiving IV AED reports that their groin is itching. Which drug are they on?
fosphenytoin
A patient on carbamezepine comes in with an infection. What are the concerns?
- BM suppression
- drug interactions with lots of anti-infectives
A patient on valproic acid complains of nausea, anorexia, and abdominal pain. Which side effect is most worrying?
Hepatotoxicity/pancreatitis
